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MONITORING WELL INSTALLATION REPORT <br /> Date: LIZ ZZ CONSTRUCTION <br /> Premise Address:CK04 � � Total Depth <br /> Screen Length (from) (to) yS <br /> Well No.: Filter Pack (from)' (to) ) <br /> Bentonite (from) (to) 3 ` <br /> Inspector. C o ' Grout (from) '3sL (to)=� <br /> Drilling rig type <br /> Permit No. Auger O.D. ' z I.D. <br /> Completion - Stove pipe/chrisde box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> eight <br /> Consultant �` T <br /> _ T <br /> Geologist ABOVE-GAOUND <br /> COA�V�TION CCMPLE$OX <br /> COMPL`�iICN <br /> SPECIAL PERMIT INFO. , ) Ground Sui"n <br /> Distance to sewer line u✓1� grout <br /> Domestic well on site - ( y <br /> If yes, location and distance - tL <br /> ft. <br /> = e <br /> — e <br /> _ - c <br /> SAMPLING doral <br /> on <br /> Holding Temperapre G = pavd padt <br /> Method <br /> Screening Method n <br /> Tracking Sheet - r / n ) <br /> r = Z M <br /> SPOILS <br /> Storage Me[hod C� _ MATERIALS/DEVELOPMENT <br /> Contamination Noted'- KY n ) <br /> Storage Location 6u�) .. r :'tr✓ Casing type <br /> Blank ft. Screen %i? O ft. <br /> Slot size 9 Ci-Z 6 <br /> GROUTING Bags cement <br /> Buckets bentonite 7j <br /> Depth to water Z Bags sand/grave1 74� <br /> MixRados 1YO41 v✓ - l> ,4r ww ;; Filter Pack type/size s*�e <br /> Installation Method ✓vw , Surge Block: - ( y n <br /> Quantity Installed Discussed with geologist: - / n ) <br /> Type of method <br /> EH 29 29 <br />